Presentation
Patient with frank jaundice, associated with sudden weight loss and a painless palpable mass in the right hypochondrium.
Patient Data
The enlarged gallbladder is observed, with the presence of peripheral free fluid, which corresponds to perivesicular edema, observed on T2.
Dilation of the intra and extrahepatic bile duct, as well as the pancreatic duct, can also be observed.
There is heterogeneity in the intensity signal of the pancreatic parenchyma, visualizing a hypointensity mainly at the level of the pancreatic head, it is better observed in axial T1, coronal T1 and fat sat, this mass causes a mechanical obstruction of the bile duct and subsequently a secondary dilation of the same.
Case Discussion
The Courvosier-Terrier sign refers to the presence of painless jaundice and an enlarged gallbladder (or mass in the right upper quadrant), often being more likely to be the presence of an obstructive pancreatic or biliary neoplasm, stones or other rare etiologic factors 1.
These findings are based on the fact that stones can irritate the bile duct and gallbladder, causing chronic inflammatory changes leading to fibrosis, and preventing dilated biliary congestion from occurring 2.
However, if this blockage is due to other causes, especially compression by a tumor, gradually increasing retrograde hydrostatic pressure will result in a large and flexible gallbladder 3.
Authors: Ortega Angel M.Sc. Radiologist. Mónica Morales Monzón MD, radiology resident.
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